Provider Demographics
NPI:1033797949
Name:CABRERA LOPEZ, LUIS ALBERTO
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:CABRERA LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 NW BRONCO TER
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-1148
Mailing Address - Country:US
Mailing Address - Phone:305-747-3146
Mailing Address - Fax:
Practice Address - Street 1:675 NW BRONCO TER
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-1148
Practice Address - Country:US
Practice Address - Phone:305-747-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-20-118088106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician